Vol 72, No 3 (2023)

BACKGROUND: The prevalence of external genital endometriosis is high, yet there is insufficient understanding of its etiology and pathogenesis. This coupled with the challenges posed by its diagnosis and treatment, and its co-occurrence with type 1 diabetes mellitus, underscores the significance of this issue.

AIM: The aim of this study was to evaluate the expression of survivin in the eutopic endometrium, endometriotic lesions, and their concomitant conditions in patients with external genital endometriosis and type 1 diabetes mellitus.

MATERIALS AND METHODS: This study enrolled 43 female patients of reproductive age who were divided into four groups. The main group (n = 17) included women with surgically and histologically confirmed external genital endometriosis combined with type 1 diabetes mellitus. The external genital endometriosis group (n = 9) comprised women with isolated external genital endometriosis, while the type 1 diabetes mellitus group (n = 6) included patients with type 1 diabetes mellitus only. Finally, the control group (n = 6) consisted of women without any gynecological pathology. Biological specimens were collected during the follicular phase of the menstrual cycle, and morphological examination was carried out through histological and immunohistochemical evaluation of the endometrium and endometrioid heterotopias. Statistical analysis of the data was performed using the Jamovi software program, with statistical significance defined as p < 0.05.

RESULTS: Our findings indicate that patients with external genital endometriosis and comorbid type 1 diabetes mellitus exhibit a statistically significant increase in survivin expression in the endometrium compared to the control group or patients with type 1 diabetes mellitus only. However, no significant difference was observed in survivin expression in endometriotiс lesions between patients with external genital endometriosis and those with external genital endometriosis combined with type 1 diabetes mellitus.

CONCLUSIONS: The data obtained suggest the role of survivin in the pathogenesis of external genital endometriosis, regardless of the presence of type 1 diabetes mellitus.

BACKGROUND: The prevalence of gestational diabetes mellitus has increased significantly and has become a global health problem, affecting 9.3–25.5% of pregnant women worldwide. Violation of the interaction of various body systems with the intestinal microbiota can be the cause of the development of insulin resistance. The study of the state of the intestinal microbiota based on the results of the study of the species composition of microorganisms in feces by the polymerase chain reaction method is necessary to understand the mechanisms of gestational diabetes mellitus development.

AIM: The aim of this study was to evaluate the intestinal microbiota status in women with normal pregnancy and pregnancy complicated by gestational diabetes mellitus.

MATERIALS AND METHODS: We examined 51 pregnant women in the period 2020-2022. The average age of women with normal pregnancy (n = 20) and pregnancy complicated by gestational diabetes mellitus (n = 31) was 29 (27.0; 32.5) and 31 (27.0; 35.0) years, respectively. The intestinal microbiota status was assessed based on the microbial species composition in feces using real-time polymerase chain reaction. All women underwent a test for carbohydrate metabolism at various gestation periods.

RESULTS: We have established a positive relation between Bacteroides thetaiotaomicron and Body Mass Index before pregnancy (r = 0.42). The number of Bacteroides thetaiotaomicron in the 1st, 2nd and 3rd trimesters of gestation positively correlated with the initial weight of women before pregnancy (r = 0.60, r = 0.52, r = 0.47, respectively; p < 0.05). The Bacteroides spp. / Faecalibacterium prausnitzii ratio in women with gestational diabetes mellitus was negatively correlated with the average blood glucose level in the 3rd trimester of pregnancy (r = –0.81; p < 0.05). Parvimonas micra positively correlated with venous plasma glucose levels in the presence of gestational diabetes mellitus (r = 0.58; p < 0.05). A positive relationship was obtained between the number of Escherichia coli in pregnant women in the 1st trimester and the average glucose level in the 3rd trimester of pregnancy (r = 0.41; p < 0.05). It was demonstrated that the growth of Bacteroides fragilis in the large intestine of pregnant women with gestational diabetes mellitus in the 3rd trimester of pregnancy correlated with subnormal blood glucose levels (r = –0.77; p < 0.05), which may be due to a diet disorder (insufficient carbohydrate intake) or insulin overdose, which can lead to hypoglycemic conditions. In the group of women with gestational diabetes mellitus, a positive correlation was obtained between glycated hemoglobin level and the opportunistic pathogen Klebsiella pneumoniae representative amount in the 1st trimester of pregnancy (r = 0.46; p < 0.05). In addition, we have found positive relations between the Citrobacter spp. / Enterobacter spp. ratio and the maximum blood glucose level in women with gestational diabetes mellitus in the 1st, 2nd and 3rd trimesters of pregnancy (r = 0.49, r = 0.43, r = 0.47, respectively; p < 0.05). The difference in the intake of dietary fiber in the control group and in the group of pregnant women with gestational diabetes mellitus was obtained: 2 (1; 3) and 1 (1; 1), respectively (p < 0.05).

CONCLUSIONS: Data have been obtained confirming the relationship between disorders of the colon microbiocenosis and carbohydrate metabolism in pregnant women with gestational diabetes mellitus. A relationship has been found between insufficient intake of dietary fiber and the risk of developing gestational diabetes mellitus.

BACKGROUND: Patients with endometriosis-associated pain syndrome in combination with anxiety or depression have lower treatment effectiveness and satisfaction with both the disease itself and the pain syndrome compared to patients with pain syndrome but without depression or anxiety.

AIM: The aim of the study is to assess the relationship between psychosocial status and endometriosis-associated pain syndrome in patients with different phenotypes of endometriosis using pain assessment scales, psychosocial state assessment scales, and quality of life assessment scales.

MATERIALS AND METHODS: We examined 81 patients using a number of questionnaires: Visual Analogue Scale, Numeric Rating Scale, Hospital Anxiety and Depression Scale, Beck Depression Scale, Spielberger State-Trait Anxiety Inventory, and Short Form-36 quality of life assessment. The patients were divided into three groups: isolated adenomyosis (n = 39), adenomyosis combined with external genital endometriosis (n = 21), and the control group (n = 21).

RESULTS: Our study has shown that patients with adenomyosis combined with external genital endometriosis had the highest scores on all questionnaires for assessing anxiety and depression, as well as a low quality of life in general, which significantly differed from those in the control group (p < 0.05). The results in the group of women with isolated adenomyosis are not so unambiguous and, overall, somewhat better than in the group of patients with adenomyosis combined with external genital endometriosis, but significantly worse compared to the control group. When assessing the severity of dysmenorrhea, higher scores were also found in the group of women with adenomyosis combined with external genital endometriosis: 6.64 ± 2.11 cm (Visual Analogue Scale) and 6.9 ± 2.05 cm (Numeric Rating Scale), while in the group of women with isolated adenomyosis, the scores were 5.29 ± 1.9 cm and 5.83 ± 1.72 cm, respectively (p = 0.028). Women in the control group had no pain syndrome.

CONCLUSIONS: Poor mental and physical health scores obtained in this study in women with external genital endometriosis dictate the need for an objective and multicomponent assessment of the psycho-emotional status in patients, followed by complex treatment and team management with related specialists.

Fetal growth restriction remains a leading cause of preterm birth and neurological disorders in children and is associated with high neonatal and perinatal morbidity and mortality. Fetal growth restriction is strongly associated with preeclampsia, placental insufficiency, and does not tend to decrease in frequency. The terms “small for gestational age” and “fetal growth restriction” are similar in terms of fetometry, however, in modern literature, these concepts differ based on blood flow disorders in the “mother-placenta-fetus” system and perinatal complications. A deep understanding of the multifactorial pathogenesis of early and late fetal growth restriction will allow for developing targeted therapy of placental insufficiency. Determining the role of new placental growth biomarkers plays a significant role in understanding the pathogenesis of placental dysfunction and developing measures to predict placenta-associated pregnancy complications.

This review article highlights new approaches to effective fetal growth restriction screening. Recent advances in ultrasound diagnosis of fetal growth restriction provide the basis for multivariate testing that can provide cost-effective screening for placental-associated pregnancy complications, including fetal growth restriction.

The important role of human chorionic gonadotropin in pregnancy suggests the occurrence of reproductive disorders due to the circulation of specific antibodies, especially in early pregnancy, which can lead to a cascade of pathological reactions such as implantation failure, placentation, trophoblast invasion, and ultimately fetal rejection. The lack of knowledge and the complexity of diagnosing and treating this autoimmune pathology in reproductive medicine and obstetrics negatively affects both the outcomes of each individual pregnancy and the demographic situation as a whole. This review article highlights the main ideas about the causes of human chorionic gonadotropin antibody occurrence, the pathological mechanisms, the reproductive and obstetric complications associated with human chorionic gonadotropin autoantibodies, diagnostic methods, and therapeutic approaches.

The incidence of adenomyosis in young patients who have not realized their reproductive function is steadily increasing, with the tactics of surgical and drug treatment being an unresolved problem. In clinical practice, special attention is focused on the possibility of surgical treatment of adenomyosis with preservation of the uterus; and a variety of new options for such operations are proposed, as well as ways to optimize the treatment of such patients. This article summarizes our own and world experience in managing such patients. We present current views regarding the selection of patients for such interventions and determining the indications for surgery, and we herein highlight the technical features of such interventions. A particular attention is paid to management tactics being aimed at ensuring reproductive function implementation.

We present a clinical case of giant uterine fibroids in this research, with the peculiarity of surgical treatment and the course of the postoperative period described. A series of genetic studies specific to uterine fibroids was performed, namely, mutations in the MED12 gene, overexpression of the HMGA2 gene, and chromosomal imbalance. We did not detect mutations of exon 2 of the MED12 gene and an increase in the expression of the HMGA2 gene in the patient’s myomatous node sample. The molecular karyotype arr(22)×1 (chromosome 22 monosomy) was established by comparative genomic hybridization in the tissue of giant uterine fibroids.

This article is dedicated to the 25th anniversary of modern history and the 135th anniversary of the first domestic publication of the Journal of Obstetrics and Women’s Diseases. The article traces the history of the Journal, its development and state of the art, while reflecting amazing facts, sometimes filled with drama. The Journal of Obstetrics and Women’s Diseases has become a prominent publication, thanks to which practitioners, even in the remotest corners of Russia, can be aware of advanced medical technologies and important scientific events, and acquainted with the latest achievements in the field of obstetrics and gynecology, as is evidenced by leading articles published in the Journal.